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The American Medical Association (AMA) publishes the revised Current Procedural Terminology (CPT) code set annually. This article addresses the CPT coding changes effective Jan. 1, 2021, by each section of the CPT code set.

CPT introduction

The introduction section of the CPT code set has been revised to include certain information on the publication of the CPT codes, specifically that the release of CPT data files occurs annually on or around Aug. 31, and the CPT code set is periodically updated throughout the year on a set schedule. A table was added to the introduction section, outlining the complete CPT code set update calendar.

Evaluation and management (E/M)

Extensive changes were made to the E/M office and other outpatient service codes (99202–99215). The significant revisions to E/M codes and guidelines were discussed in depth in the August 2020 (“The Devil Is in the Details”) and September 2020 (“Evaluation and Management Changes Are Coming Soon”) issues of AAOS Now.

The most notable changes to the code descriptors for 99202–99215 remove the tallying of history and physical examination key components and instead allow providers to determine the E/M levels based on either medical decision making (MDM) or time. New and revised definitions for the elements of MDM have also been added for 2021. View the CPT code book for further information.

Surgery/musculoskeletal system

A new guideline was added under the endoscopy/arthroscopy subsection, which specifies the size limit for loose body(ies) or foreign body(ies) removed in arthroscopic procedures. Users are instructed to report the appropriate codes when the loose body(ies) or foreign body(ies) is equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure.

This revision differentiates between cases of loose and foreign body removal through a cannula and those that require extracannular removal. Previously, there was no defined threshold of loose body size for the appliable arthroscopy procedure codes.

New guideline
Arthroscopic removal of loose body(ies) or foreign body(ies) (i.e., 29819, 29834, 29861, 29874, 29894, 29904) may be reported only when the loose body(ies) or foreign body(ies) is equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure, and can only be removed through a cannula larger than that used for the specific procedure or through a separate incision or through a portal that has been enlarged to allow removal of the loose or foreign body(ies).

Revised codes
Shoulder debridement codes 29822 and 29823 have been revised to specify the number of discrete structures debrided and include anatomical examples. Previously, codes 29822 and 29823 only described shoulder arthroscopy with limited and extensive debridement.

• 29822: Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])
• 29823: Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])

Surgery/nervous system

Deleted codes
Under the spine and spinal cord subsection, the cervical laminectomy codes 63180, Laminectomy and section of dentate ligaments, with or without dural graft, cervical; 1 or 2 segments and 63182, Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than 2 segments, were deleted due to low utilization.

Revised codes
The following code revisions were made under the “Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System, Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic” subsection. The anesthetic and/or steroid injection codes 64455, 64479, 64480, 64483, and 64484 have been revised as child codes to the parent code 64400, Injection(s), anesthetic agent(s), and/or steroid.

• 64455: Injection(s), anesthetic agent(s), and/or steroid; plantar common digital nerve(s) (e.g., Morton’s neuroma)
• 64479: Injection(s), anesthetic agent(s), and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level
• 64480: Injection(s), anesthetic agent(s), and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
• 64483: Injection(s), anesthetic agent(s), and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level
• 64484: Injection(s), anesthetic agent(s), and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Category III codes

The following Category III codes will be retained for another five years:

• 0213T: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• 0214T: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic second level (List separately in addition to code for primary procedure)
• 0215T: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)
• 0216T: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level
• 0217T: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; second level (List separately in addition to code for primary procedure)
• 0218T: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)
• 0219T: Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical
• 0220T: Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; thoracic
• 0221T: Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar
• 0222T: Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; each additional vertebral segment (List separately in addition to code for primary procedure)

Deleted codes
Codes 0228T, 0229T, 0230T, and 0231T have been deleted. To report injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic, single level, use the unlisted code 64999, Unlisted procedure, nervous system.

Code 0396T has been deleted. To report intraoperative use of kinetic balance sensor for implant stability during knee replacement arthroplasty, use the unlisted code 27599, Unlisted procedure, femur or knee.

Code 0595T, Removal of humeral externally controlled intramedullary lengthening device, has been deleted.

All related parenthetical notes have also been revised with these guidelines.

New code
Category III code 0X70TX was created to report osteotomy of the humerus, with the insertion of an externally lengthened intramedullary device, including imaging. Parenthetical notes have been added to instruct the appropriate reporting of this code. The intramedullary lengthening device is intended to extend the humeral shaft bone.

• 0X70TX: Osteotomy, humerus, with insertion of an externally controlled intramedullary lengthening device, including intraoperative imaging, initial and subsequent alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening device

(Do not report 0X70TX in conjunction with 20696, 24400, 24410, 24420, 24516.)

(For revision of externally controlled intramedullary lengthening device, use 24999.)

Procedures that are inherently part of the intramedullary lengthening and may not be reported in conjunction with it include the application of multiplane external fixation (code 20696); the osteotomy of the humerus (code 24400); multiple osteotomies with realignment (code 24410); osteoplasty, humerus (code 24420); and the treatment of humeral shaft fracture (code 24516).

In order to promote the submission of clean claims and reduce claim rejections, be sure the electronic health records, practice management system, and billing software always reflect the most current CPT code set.

CPT is a registered trademark of the AMA.

Michelle Abraham, MHA, CCS-P, is the coding and reimbursement coordinator for the AAOS Office of Government Relations.